Nicole Fisher is the President and CEO at HHR Strategies, a health care and human rights focused advising firm. Additionally, she is a Senior Policy Advisor and expert on health economic analyses mainly focusing on Medicare, Medicaid and health reform, specifically as they impact vulnerable populations. Nicole runs a Health Innovation and Policy page at Forbes.com highlighting and advising companies, ideas and people that are changing the health care landscape and curates a monthly health dinner series: Chicago HealthCare Dinners. She is also currently pursuing her PhD at the University of North Carolina in the Health Policy and Management Department. Her writing has appeared in other publications such as Health Affairs, Wall Street Journal, Washington Post, Centers for Medicare & Medicaid Services Journal, Wright on Health, The Health Care Blog and Health Services Research, and her talks can be found on the United Nations website. Before pursuing her PhD in health policy, Nicole earned her Master’s degree in Public Policy from the University of Chicago and her undergraduate degree from the University of Missouri. Her health care and policy work at those institutions had an emphasis on underserved populations, women's and children’s issues. She presides on several Boards for domestic and international health organizations and frequently speaks on health reform, innovation and human rights.

The SMART team has focused on enabling the property of substitutability in health IT through an application programming interface (API). This essentially allows innovators and developers who write an app to run it anywhere, and lets end users of health IT customize their systems with these substitutable apps.

He makes an analogy to the original iPhones that used cellular towers to triangulate a user’s GPS, but shifted with the present day satellite GPS. When they did so, iPhone apps kept on working. The app developers did not need to know how the underlying system measured geo-coordinates. Similarly, SMART apps don’t need to know which electronic health record or pharmacy information system is in use at any given hospital. Instead, SMART app developers, like those developers for iPhone apps, simply use the original library to make upgrades and change out necessary components.

This is exactly what developers like Justin Cranford in Raleigh, North Carolina say are ideal for functionality. “In the iPhone, the library is written by Apple, and that internal code changes, but the commands I call to build apps just pull those changes in without me ever knowing. Think about how Tinder pulls in Facebook photos and triangulates your location through the phone.” Or, as Ken Mandl quipped, “I don’t imagine that each time the creators of Angry Birds wanted to add a bird they had to fly to Cupertino for a meeting with the Apple technical team.”

This method, known as abstraction, allows technologies to be swapped out and improved inside the walls of hospitals, clinics and other care facilities. A natural extension of which might be the ability to share these substitutions and updates with patients, allowing them access not only to their data, but community and population trends inside the hospital and out – which is most important to advisors like Thomas Krohn from Eli Lilly. According to him, “I’m at the table because the pace of transformation is too slow. Measures are poor, the timeline is slow and the apps are not presently scalable. This is the real opportunity,” he believes, “to allow innovation at the point of care.”

In addition to the creative ideas and established models that SMART is built upon, significant changes to the health system and technology in the United States have made advances such as this possible. Three specific incidences have had a particularly large effect on SMART.

Second, the digitization of health care has allowed for patient information to not only be collected, but to be used. By releasing patient information, our former CTO Mr. Chopra, who has a background in health, technology and policy believes that a patient revolution is on the horizon. He contends that the ultimate way to empower patients is to give them their own data to take beyond the four walls of the hospital or institution, and that means they can also use SMART in real time.

The advisors that have come together to make SMART a reality really are a who’s who of the health industry. In addition to the former White House CTO, universities and professors of note and the largest provider health systems, there has also been buy in from key technology companies, pharma, investors and consultants.

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